Confessions of a GP Read Free

psychosis’. This is psychiatry speak for ‘slightly odd but basically harmless’.
    ‘He does love me, you know, doctor. If he met me, he would know it straight away. We’re made for each other.’
    ‘Isn’t Tom Jones happily married and living in America?’
    ‘No no no! He loves me, doctor.’ Elaine would have happily spent all afternoon telling me about her Tom Jones fantasies, but I felt that we needed to move things on. I used the classic GP phrase that we pull out of the bag when we feel that we’re not getting very far. ‘So Elaine, what are you hoping that I’m going to do for you today?’
    ‘Well, doctor, I need you to write Tom a letter. It would sound better coming from you. He’s a doctor as well. Well, not a real doctor, but I’m sure he’d be a wonderful doctor if he wanted to be. He’s very kind you know and oooh so gorgeous and anyway, I’m sure if you just explained everything he would see sense, I know he would.’
    Basically, I was being asked to stalk Tom Jones on Elaine’s behalf. I could imagine the letter.
Dear Tom,
Please will you leave your wife, family and LA mansion and move into a council bedsit with a slightly odd woman with straggly hair and a duffel coat that she has been wearing since 1983. It will make my life slightly easier as she won’t keep coming to the surgery and annoying me with her graphic descriptions of your imaginary sex life.
Best wishes,
Dr Daniels
    Stalking is defined as a ‘constellation of behaviours in which an individual inflicts upon another repeated unwanted intrusions and communications’. Elaine probably would have quite liked to have stalked Tom Jones, but I don’t think she really had it in her. For Elaine, her problems with relating to everyday folk had resulted in her focusing all her energy on an imaginary relationship with a person whom she would never meet. I guess this was a good way to protect herself from the struggles and potential rejections of real-life relationships. Whatever the psychological explanation, I’ll never be able to listen to ‘It’s Not Unusual’ in quite the same way again.

Targets
    Lucy, the practice manager, popped her head around the door: ‘I’ve put you down for a visit to see Mrs Tucker. She’s had a funny turn and fallen over. Perhaps you could diagnose her as having had a stroke?’
    It is January and our Quality and Outcomes Framework (QOF) targets are due in April. None of our patients has had a stroke in the last nine months. This should, of course, be a cause for celebration, but Lucy is not happy. If no one has a stroke before April, we will miss out on our ‘stroke target’. The government tells us that if a patient has a stroke, we need to refer him/her to the stroke specialist and then we’ll get five points! But if no one has a stroke, we miss out on the points and the money that comes with them. The more QOF points the practice earns, the more money the partners take home as profit. The practice manager also takes her cut as an Easter bonus if the surgery gets maximum points. In the world of general practice, points really do mean prizes.
    Some older GPs hate disease guidelines. They feel that they take away our autonomy as doctors and rob us of our integrity and ability to make our own clinical decisions. I myself don’t begrudge guidelines at all. Strokes have been poorly managed in the community for years and some good research has shown that if someone has a stroke or a mini stroke and we sort out their cholesterol and blood pressure and send them to see a stroke specialist, we can genuinely reduce the chance of them having another stroke.
    Mrs Tucker is 96 and lives in a nursing home nearby. She is severely demented and doesn’t know her own name. In her confusion she wanders around the nursing home and frequently takes a tumble. She had fallen over again today and could well have had a mini stroke. Having said that, she could just as easily have simply tripped over a stray Zimmer